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Pressures Mounting on Ontario’s Emergency Departments

“The overcrowding of emergency departments is probably the largest impediment in our health care system to deal(ing) with any surge event,” the Ontario-based Centre for Excellence in Emergency Preparedness wrote a decade ago.

“Hallway patients and those waiting in emergency departments … are effectively occupying the ‘extra’ capacity required should there be a sudden surge of new patients. Dealing with this issue must receive high priority in any health care system that wishes to prepare itself for disaster.”

Have matters improved over the past decade?

As we face the uncertain challenges posed by every influenza season, the latest status report by Health Quality Ontario on emergency departments (EDs) in the province provides no clear answers.

“As Ontario's population grows and ages and emergency visits continue to increase, the pressure on emergency departments to handle more and sicker patients with greater efficiency – and on the health system to help keep patients from needing emergency care – will likely continue and even intensify,” states Under Pressure: Emergency Department Performance in Ontario.

The report shows growth in emergency department visits is outpacing population growth – including more visits from older patients who often require more complex care. As well, many of the sickest patients in the province – those who need to be admitted to hospital – have to wait a long time in the emergency department for a bed in an inpatient ward.

None of this should come as a surprise to those reading newspapers or following social media discussions among emergency room physicians recently, where the challenges facing EDs as a result of pressure on the whole system is highlighted.

The Health Quality Ontario report not only provides a variety of statistics on care in EDs but also discusses broader trends impacting those departments.

For example, it notes that in 2013 almost half of adults in Ontario reported going to an ED for a condition they thought could have been treated by their primary care provider – if that provider had been available. This rate is higher than other comparable countries in Europe.

The report also discusses a number of initiatives undertaken to reduce wait times in emergency departments but adds “it’s difficult to know precisely how and to what degree each of these initiatives has helped reduce emergency department length of stay and wait time to see a doctor, or improved performance in other quality measures.”

“What's needed now is careful evaluation of the actions that have been taken to determine which have been most effective and how they should be carried into the future.”

While the report concludes “that won’t likely be enough,” there is no need to be alarmist.

Staff in our EDs continue to provide excellent care and the Health Quality Ontario report found the majority of people presenting in the province’s EDs feel they are receiving good or excellent care.

The message should not be one of impending disaster but rather the need to introduce reforms to the system as a whole which will help relieve pressures which are often seen to be most intense in the emergency departments.

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